Table 5.

Guideline recommendations regarding non-iron-based management of HMB

Citation	Transfusion	Dietary interventions
ACOG Opinion #785 [51]	If Hb < 7 g/dL In hemodynamically unstable patients/presence of active bleeding	First-line therapy and long-term management: oral iron administration plus dietary optimization
Arab HA et al [62]	In asymptomatic patients if Hb < 5 g/dL In symptomatic patients if Hb < 6 g/dL	Increasing consumption of foods rich in heme iron
Health Quality Ontario [57]	With severe symptoms of anemia	N/S
Munro MG et al. [5]	In acute hemorrhage/hemodynamic instability	N/S
American College of Nurse-Midwives [53]	N/S	Nutrition counseling and iron replacement

Five out of 22 guidelines provided recommendations on the use of non-iron-based management of ID/IDA in women presenting with HMB. Transfusion is sometimes recommended in cases of severe anemia, especially in the event of hemodynamic instability [5, 51, 57, 62]. Dietary interventions may be considered alongside other approaches [51, 53, 62]

ACOG American College of Obstetricians and Gynecologists, Hb hemoglobin, HMB heavy menstrual bleeding, ID iron deficiency, IDA iron-deficiency anemia, N/S not stated